Dear All
We had a chap yesterday, who had a Callor gas cooker blow up in his face,
causing partial thickness burns with blistering over his entire face from
forehead to chin, with blistering of his upper lip in particular.

What would everyone use to dress this area - obviously, jelonet is
impracticle over the entire face. We used white parafin - Is this acceptable
practice? I couldn't think of many other options at the time ( or now ! )

Judith Haslam
A&E SHO
Ipswich

----- Original Message -----
From: Simon Carley <[log in to unmask]>
To: acadae messages <[log in to unmask]>
Sent: Tuesday, February 22, 2000 12:19 PM
Subject: Re: Dressing burns - flamazine


> There is lot of research out there on what burn dressing is best when
> compared to Jelonet [1-8 below]. Most of it
> is not very good (v. small numbers). Locally we tend to use Jelonet but
its
> not an absolute. caveat - The search below was v. quick so I may have
missed
> a fair amount.
>
> The question of lignocaine jelly is worth mentioning [1]. Unliklely to get
> problems with a small burn as you describe, but there are certainly
> anecdotal tales of lignocaine toxicity and death from systemic absorbtion
of
> lignocaine through the burn . However, could not find a reference to
relate
> to specific incident - only [1] which advises caution
>
> Simon
>
> Simon Carley
> SpR in Emergency Medicine
> Manchester Royal Infirmary
> Manchester
> England
> [log in to unmask]
> ---------------
> TOXICITY
> [1]
> Unique Identifier
> 80259094
>
> Authors
> Read JM. Bach PH.
> Title
> Sterile topical lignocaine jelly in plastic surgery: an
> assessment of its systemic toxicity.
>
> Source
> South African Medical Journal. 57(17):704-6, 1980 Apr 26.
>
> Local Messages
> Held at BMA Library
>
> Abstract
> Topical local anaesthesia offers an important adjunct to several plastic
> surgery procedures, provided that it does not cause systemic toxicity or
> prevent the healing process. Absorption of a sterile topical lignocaine
> jelly was assessed in patients undergoing treatment of skin graft donor
> sites, flap donor sites and burns. There was a marked degree of absorption
> only in patients with thermal burns, in which case it depended on the
> surface area of the wound; although no toxic effects due to absorption
were
> noted, caution in dosage is advisable. No complications of healing
> attributable to the preparation used were encountered.
>
>
> -----------------------------------------
> JELONET VS. ????
> Medline 1966 to present
> # Search History Results
> 1 "JELONET".mp. 15
> 2 exp paraffin/ or "paraffin".mp. 17000
> 3 1 or 2 17009
> 4 exp silver sulfadiazine/ or "flamazine".mp. 391
> 5 3 and 4 1
> 6 Burns/ 20574
> 7 limit 6 to (human and english language and abstracts) 5928
> 8 3 and 7 16
> 9 from 8 keep 2-4,9,11,13-15 8
>
> Citation 1
> Unique Identifier
> 97066279
>
> Authors
> Ebbehoj J. Gavrilyuk BK. Menzul VA. Paklin EL. Rochev YuA.
> Institution
> BIOCOL Ltd, Pushchino, Russia.
> Title
> Controlled trial of Biocol versus Jelonet on donor sites.
>
> Source
> Burns. 22(7):557-9, 1996 Nov.
>
> Abstract
> A controlled study of healing time in donor sites covered with Biocol, a
new
> latex-based material, compared with donor sites covered with Jelonet
showed
> a shorter healing time after treatment with Biocol (P < 0.001). No
> significant difference in cosmetic results 3 months post wounding was
> observed. No difference in discomfort was observed.
>
> --------------------------------------------------------------------------
--
> ----
> Go to ... Help | Logoff
>
> Citation 2
> Unique Identifier
> 97066274
>
> Authors
> Platt AJ. Phipps A. Judkins K.
> Institution
> Yorkshire Burn Centre, Pinderfields General Hospital, Wakefield, UK.
> Title
> A comparative study of silicone net dressing and paraffin
> gauze dressing in skin-grafted sites.
>
> Source
> Burns. 22(7):543-5, 1996 Nov.
>
> Abstract
> This prospective randomized study has compared paraffin gauze dressing (n
=
> 19) with silicone net dressing (Mepitel, n = 19) applied as the first
layer
> to newly grafted burn wounds. At the first postoperative dressing visual
> analogue pain scores were greater in the paraffin gauze group (mean 4.4)
> than in the silicone net group (mean 1.4, P < 0.01). All patients in the
> paraffin gauze group experienced some degree of pain on dressing removal,
> whereas 53 per cent of patients in the silicone net group experienced no
> pain. Overall graft take was similar in both groups, (silicone net mean
95.7
> per cent; paraffin gauze mean 94.3 per cent). Dressings were harder to
> remove in the paraffin gauze group as assessed by a simple scoring system
(P
> < 0.001). In conclusion silicone net dressing confers advantages over
> conventional paraffin gauze, especially in reducing patient discomfort
> during dressing changes.
>
> --------------------------------------------------------------------------
--
> ----
> Go to ... Help | Logoff
>
> Citation 3
> Unique Identifier
> 96337561
>
> Authors
> Cadier MA. Clarke JA.
> Institution
> Department of Plastic and Reconstructive Surgery, Queen Mary's University
> Hospital, London, England, UK.
> Title
> Dermasorb versus Jelonet in patients with
> burns skin graft donor sites.
>
> Source
> Journal of Burn Care & Rehabilitation. 17(3):246-51, 1996 May-Jun.
>
> Abstract
> A prospective and randomized trial that compares Jelonet (Smith & Nephew
> PLC, London, England) with a new hydrocolloid dressing, Dermasorb
(Convatec
> Ltd., Clwyd, United Kingdom), is presented. The dressings were applied on
> contiguous donor sites in 21 patients that required skin grafting for burn
> wounds. Pain experienced with the dressing in situ was assessed on days 2,
> 4, 7, and on two subsequent occasions. During dressing changes, pain
> experienced was again assessed, bacteriologic swabs were taken, and the
> percentage of epithelialization was recorded. Questionnaires completed by
> investigators and patients were used to assess the perceived performances
of
> both dressings. The results showed that Dermasorb is a less painful
dressing
> than Jelonet, in which wounds heal faster. Dermasorb was preferred by both
> investigators and patients. No clinical or laboratory evidence of any
> differences of colonization or infection were found. All results were
> statistically significant. We would strongly recommend the use of
Dermasorb
> as a split-thickness skin graft donor site dressing for a patient with
> burns.
>
> --------------------------------------------------------------------------
--
> ----
> Go to ... Help | Logoff
>
> Citation 4
> Unique Identifier
> 91234232
>
> Authors
> Poulsen TD. Freund KG. Arendrup K. Nyhuus P. Pedersen OD.
> Institution
> Department of Orthopedic Surgery, Esbjerg Central Hospital, Denmark.
> Title
> Polyurethane film (Opsite) vs. impregnated gauze (Jelonet)
> in the treatment of outpatient burns: a prospective,
> randomized study.
>
> Source
> Burns. 17(1):59-61, 1991 Feb.
>
> Abstract
> As it has been shown that re-epithelialization of partial skin thickness
> wounds can be accelerated if the wound is kept moist, a prospective,
> randomized clinical study compared the water vapour-semipermeable
> polyurethane film, Opsite, with the conventional impregnated gauze
dressing,
> Jelonet, in the treatment of outpatient partial skin thickness burns.
> Fifty-five patients were included: 30 were treated with the polyurethane
> film and 25 with the conventional dressing. The patients were followed at
> regular intervals until healing had occurred and were seen 3 months later
> for evaluation of residual scars and pigmentation. The burns treated with
> polyurethane films healed with a median of 10 days, while the
conventionally
> treated burns healed with a median of 7 days (P greater than 0.05).
Residual
> scars were noted in 21 per cent of the patients treated with polyurethane
> films and in 8 per cent treated conventionally (P greater than 0.05).
> Prophylactic methods should be publicly stressed since one-quarter of the
> patients were children of 3 years or less who were scalded by split hot
> liquids. Furthermore the patients' wounds were only briefly cooled before
> attending medical care. With small burns we advise that cooling should be
> prolonged until the pain fades then professional assistance should be
> sought.
>
> --------------------------------------------------------------------------
--
> ----
> Go to ... Help | Logoff
>
> Citation 5
> Unique Identifier
> 90347664
>
> Authors
> Jonkman MF. Bruin P.
> Institution
> Department of Dermatology, University Hospital, Groningen, The
Netherlands.
> Title
> A new high water vapor permeable polyetherurethane film dressing.
>
> Source
> Journal of Biomaterials Applications. 5(1):3-19, 1990 Jul.
>
> Abstract
> This study summarizes the Ph.D.-research project concerning the
development
> of a new high water vapor permeable wound dressing. The dressing is
composed
> of a 15 microns thin polyetherurethane (PEU) film, which has many
> non-interconnected cavities to enable a high water vapor permeability up
to
> 20.1 g.m-2.h-1.kPa-1. Since only water vapor permeates through the PEU
> dressing, the wound exudate underneath is condensed into a gelatinous
> coagulum. Epithelialization was accelerated by 25% under the
clot-permissive
> PEU film compared with the fluid retaining OpSite film. In clinical
> situations on donor sites and grafted full-thickness burn wounds, the PEU
> film indeed prevented fluid accumulation and induced the formation of a
> "red" coagulum underneath. It furthermore reduces pain significantly
> compared to conventional paraffin gauze dressing. In conclusion, the
optimum
> environment for epithelialization is a wound, in which the exudate is
> permitted to gelatinize between moist and dry.
>
> --------------------------------------------------------------------------
--
> ----
> Go to ... Help | Logoff
>
> Citation 6
> Unique Identifier
> 89351689
>
> Authors
> Jonkman MF. Bruin P. Pennings AJ. Coenen JM. Klasen HJ.
> Institution
> Department of Histology and Cell Biology, University of Groningen, The
> Netherlands.
> Title
> Poly(ether urethane) wound covering with high water vapour permeability
> compared with conventional tulle gras on split-skin donor sites.
>
> Source
> Burns. 15(4):211-6, 1989 Aug.
>
> Abstract
> The experimental poly(ether urethane) (PEU) wound covering with a high
water
> vapour permeance was compared with tulle gras treatment on adjacent areas
of
> the same 20 split-skin donor sites. All patients experienced little or no
> pain from the PEU-covered areas, while 70 per cent of the patients
> complained of more pain from the tulle gras-covered areas. The PEU
covering
> did not absorb the wound exudate underneath, neither did it retain wound
> fluid, but turned the wound exudate into a jelly-like clot layer by
allowing
> a high evaporative water loss from the wound. Tulle gras treatment also
> prevented wound desiccation, but the exudate was absorbed into the
> overlaying cotton pads, where it became dry at the outer surface.
Microscopy
> revealed that re-epithelialization occurred at a similar rate under the
PEU
> covering as under tulle gras. In conclusion, the high water vapour
permeable
> PEU wound covering prevents fluid retention, induces clotting of the wound
> exudate and reduces pain in split-skin donor sites. Tulle gras dressed
with
> gauzes and crepe bandage prevents wound desiccation, but causes more pain.
>
> --------------------------------------------------------------------------
--
> ----
> Go to ... Help | Logoff
>
> Citation 7
> Unique Identifier
> 89248590
>
> Authors
> Healy CM. Boorman JG.
> Institution
> Welsh Regional Plastic Surgery, St Lawrence Hospital, Chepstow, Gwent, UK.
> Title
> Comparison of E-Z Derm and Jelonet dressings for partial
> skin thickness burns.
>
> Source
> Burns, Including Thermal Injury. 15(1):52-4, 1989 Feb.
>
> Abstract
> A prospective, randomized trial of 32 patients with partial skin thickness
> burns is reported comparing E-Z Derm with Jelonet as a burn dressing. The
> bacterial colonization rate, need for surgical treatment, time for
> spontaneous healing, analgesic requirements and frequency of dressing
> changes were assessed in each group. No statistically significant
> differences were found between the two groups, for any of these factors.
>
> --------------------------------------------------------------------------
--
> ----
> Go to ... Help | Logoff
>
> Citation 8
> Unique Identifier
> 89277632
>
> Authors
> Donati L. Vigano M.
> Institution
> Department of Plastic Surgery, University of Milan, Italy.
> Title
> Use of the hydrocolloidal dressing duoderm for skin donor sites for
> burns.
>
> Source
> International Journal of Tissue Reactions. 10(4):267-72, 1988.
>
> Abstract
> We have made a study of the use of Duoderm hydroactive sterile occlusive
> dressing on 10 patients for skin donor sites. Its therapeutic efficacy is
> evident and the dressing enhances the wound debridement and accelerates
the
> re-epithelialization, with complete healing in 8.5 days on the average. In
> comparison with a conventional dressing with paraffin gauze, Duoderm
allows
> a more rapid re-epithelialization. In addition, the new skin is softer,
> smoother and more homogeneous. Duoderm is also easy to use and is well
> tolerated by the patients.
>
> -----Original Message-----
> From: Robbie Coull <[log in to unmask]>
> To: acad-ae-med mailing list <[log in to unmask]>
> Date: 22 February 2000 09:05
> Subject: Dressing burns - flamazine
>
>
> >I came into conflict with a practice nurse recently re: dressing of a
> >partial thickness 10x4cm burn on a child's hand from a failed attempt at
> >making a petrol bomb.
> >
> >I was keen to use jelonet (possibly with lignocaine gel but in fact the
> >wound was not that painfull) but the local policy is flamazine.
> >
> >After 3/7 (the second review) the central area appeared less viable and I
> >sent him to the local surgeons.
> >
> >For uninfected burns I have never been too keen of flamazin e because of
> the
> >possibility of staining and macceration, the later making review more
> >difficult.
> >
> >What is the most current thinking in A+E on burn dressings?
> >
> >
> >Dr Robbie Coull
> >Locum GP
> >BASICS Immediate Care Doctor
> >ALS Instructor
> >
> >
> >email: [log in to unmask]             website: http://www.coull.net
> >
> >
> >
>
>
>



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